Beard D.1, Paez A.2, Hamilton D.3, Davies L.1, Cook J.1, Hirst A.1, McCulloch P.1
1University of Oxford, Oxford, United Kingdom, 2Northeastern University, Physical Therapy, Boston, United States, 3University of Edinburgh, Edinburgh, United Kingdom
Background: Whilst there have been recent improvements, the practice and profession of physiotherapy (Physical Therapy) has suffered from the uncontrolled introduction and proliferation of treatments which have an inadequate scientific basis, little or poor evaluation, and underexposure to rigorous scientific method. New treatment modalities can be developed and introduced without evidence of efficacy, regulation or governance. There is no requirement to collect prospective data to support any claims or demonstrate efficacy. This approach has resulted in numerous disparate practices which may not stand up to rigorous evaluation or evidence based commissioning.
Purpose: The IDEAL framework is an established method of formalising the systematic evaluation of innovation (and existing practice) in complex clinical interventions. It has been useful for setting out an internationally based evaluation framework for surgical procedures. This framework lends itself to other complex, non-pharmacological interventions such as Physiotherapy (Physical Therapy). We outline the application of this framework to Physiotherapy (Physical Therapy) in a new IDEAL-Physio framework.
Methods: Similarly to IDEAL for surgery, five stages exist; each representing a letter of the acronym.
Stage 1, the Idea phase where formal data collection should begin. This requires quality recording of data using standardised outcome measures. The emphasis is on explanation and description.
Stage 2a, the Development phase, is a period of iterative improvement and adjustment with thorough prospective data recording. It focuses on technical details and feasibility.
Stage 2b, the onset of formal Exploration evaluation using systematically collected group or cohort data. This stage is a bridge or a pilot to a full RCT. It further refines outcome measures and takes account of learning curves.
Stage 3, is a formal comparative Assessment phase of treatment usually involving randomised studies. It involves a full assessment of efficacy.
Stage 4, Long term follow up involves monitoring outcome, particularly in long term conditions.
Results: Whilst the application of IDEAL in the surgical community has been very successful and has many referenced contributions, IDEAL- Physio is a new initiative.
Conclusion(s): We recommend the use of IDEAL - Physio to help guide and evaluate innovation with the overall strategy of providing better evidence based care and foster innovation in Physiotherapy (Physical Therapy).
Implications: This paper outlines the principles of IDEAL Physio and describes its utility in changing practice on a global level. If IDEAL - Physio is taken up it could provide a systematic ordered introduction of new treatments and a framework for the ongoing evaluation of PT treatment.
Funding acknowledgements: This project is supported by SITU (Surgical Intervention Trials Unit) and by the Royal College of Surgeons of England.
Topic: Research methodology & knowledge translation
Ethics approval: No ethics required. Description of a new framework.
All authors, affiliations and abstracts have been published as submitted.
